NewPublicHealth: What is the focus of the panel discussion you’re a part of?

Cynthia Hallett: We will be sharing some of our collective experiences on successful health policy efforts and some of the resources that would be available for others as they’re thinking about what kind of health policies they want to try to pursue at the community level.

NPH: What will you be presenting about tobacco?

Cynthia Hallett: We’ve got more than thirty years of experience looking at how to engage in tobacco control policy development. Part of my charge is to talk to the audience about how campaigns emerge, how laws and policies get enacted, and to listen to the way they think these things happen. We’ll weave in a little bit about how to implement policies. Often there are concerns that there will be challenges or that it will be too difficult, or questions about who’s going to handle enforcement. And we’ll share tools and resources that are available. I’m going to be talking quite a bit about just how to engage the local grassroots citizen community, as well as the other parties such as business owners. It’s critical to get them engaged and involved in learning about the health effects of secondhand smoke and the benefits of smoke-free policies, and then to engage them in campaigns to educate the community as well as to enact the law.

NPH: Do you have a specific examples to share?

Cynthia Hallett: I often share the overarching message that back in the ‘70s, when the non-smokers’ rights movements first began, we didn’t have the wealth of science that we have today about the health effects of secondhand smoke on the non-smoker. So at the time, as an advocacy group, we focused on the non-smoker and how to make your workspace smoke-free. We focused on first on non-smoking sections. “I want my desk in this workplace to be smoke-free.” “I at least would like to see a section of the restaurant where I could sit.” And then over time, the research community was then able to evaluate the health effects of secondhand smoke on the non-smoker, which we knew was bad, but we didn’t know how bad it was. The figure today is that an average of 53,000 non-smokers is injured or dies from secondhand smoke exposure every year. So, we as an organization then changed our policy goal beyond sections to 100% smoke free at all times. No exemptions for certain types of businesses or small businesses, no exemptions for ventilation that exhausts directly to the outside air and doesn’t recirculate because ventilation cannot remove all of the gases and particulates that are in secondhand smoke. I think it demonstrates a relationship between policy action and the research community and how it’s a sort of circular effort where we keep learning from one another.

Today we have the science to demonstrate that secondhand smoke is dangerous and not only should non-smoking patrons be protected, but this is really an issue about employee health and safety. I was recently at the Global Gaming Expo, which looks at, among other things, state and federal regulations concerning casino expansion. And I’m the little public health advocate, trying to remind people that if they’re worried about losing their player base, if 80 percent of the population doesn’t smoke, perhaps they’re not coming in to your casino because of the smoke. You’ve got this huge untapped market to be bringing in new players. In addition, all of your employees—whether you have a non-smoking area on your gaming floor or just smoking in its entirety—are being exposed to a known carcinogen and you’re endangering their health.

I wasn’t very popular there, but what I’m doing is sort of the extreme example of working at the community level. Educate the community so that they understand the problem and the potential of going smoke-free. In this instance it’s not a city or a state, it’s the gaming industry and we’re trying to get them to understand that we’re not anti-gaming. We are anti-smoke and we want smoke-free casinos so that the workers have a healthy and safe workplace and that patrons can come safely in as well. Their argument, of course, is everybody who gambles smokes, and so we’re trying to get information to them that illustrates otherwise.

NPH: And, of course, smoking is a great example of changing policies, at least in some places.

Cynthia Hallett: One would have never, ever have thought that cities in tobacco growing states would ever go smoke-free, and yet we’ve seen phenomenal changes. In 2009 even North Carolina, one of the leading tobacco growing states, strengthened their statewide law, and they now have a smoke-free restaurant and bar law.

NPH: How important is it for the work you do that there is now the Network for Public Health Law, know an entity that helps understand what the legal avenues are toward improving the public’s health?

Cynthia Hallett: I think it’s an incredible resource and it’s definitely something that we, as an organization, and certainly I, as an individual, wished that we had this cohort of legal expertise to be able to give us advice. From the tobacco control perspective, we were fighting the tobacco industry that has just a cadre, an army, of lawyers protecting them. While we understand these lawyers aren’t giving us legal advice for particular cases, but general guidelines, it is so helpful to have this partnership and to have this legal expertise to make sure that we are moving in the right direction. It’s great to know that there is this resource out there to both give us some assistance but also to be a partner.

NPH: What are some of the areas of assistance from the Network you’d highlight?

Cynthia Hallett:Preemption—when federal law preempts state law that is in conflict or inconsistent with federal law, or the same at the state and local levels—as an issue is enormous and we’ve certainly had to deal with it within the tobacco control movement. We’re starting to see it with food and nutrition policy.

It’s good to have the legal expertise because you want one uniform standard that will be applied across all states at all times. It’s good to be able to have the legal expertise to help us understand better how to identify preemptive language when it’s in bills, how to counter it, how to develop other language so that we can have explicit anti-preemption language in statewide or federal bills. We, as public health experts and advocates, have a certain level of understanding, but sometimes you need that legal expertise to help us identify potential problems that we just don’t know. The lawyers can read through some of the lingo better than we can.

We from the public health side sometimes need to educate the lawyers too. Sometimes city attorneys and other lawyers are a little too narrow in their interpretation and their definitions and so we really want to make sure that there is this cross-pollination of expertise so that we both understand what the intent of the law is and that the language matches that.